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Is ECG stress test enough?

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Posted 8/8/2014 6:57 PM (GMT 0)
New to this forum but regular member of prostate forum. Have been on Flomax (alpha blocker) since mid June with a couple of stand up too fast dizzy spells until this past Tuesday morning's 4-mile hike. I normally have a 70 minute, stationery bike work out but have been reduced to the hike after Brachy Thearapy seed implants for prostate cancer.

At about mile three pain in left arm, left shoulder, neck, and headache came on. Looked for a shady spot to stop and felt light headed. Managed trip to living room and noticed a lot more sweat than usual.

GP says heart sounds good and EKG is normal. BP varies from 120/60 to 140/90 with most readings about 130/78. I jut turned 66 and have always worked out over 350 day per year. No smoking or alcohol with lots of heart illness in family history.

GP wants me to do a nuclear stress. I am worried about adding more radiation to my system with 81 p103 seeds already implanted. Would ECG stress test be just as useful in determining my prognosis?

Post Edited (browntrout) : 8/8/2014 1:04:36 PM (GMT-6)

Posted 8/10/2014 1:19 AM (GMT 0)
Good question about the radiation, I happened across an article a while ago that answers your question.

www.kevinmd.com/blog/2011/03/restricting-nuclear-cardiac-stress-testing-favor-stress-echocardiography.html

The salient paragraph follows, though I recommend you read the entire article.

"All other things being equal, a safer test is preferable to a riskier test, and a less expensive test is preferable to a more expensive test. Guess what? With respect to “all other things,” nuclear and sonographic cardiac stress testing are essentially equal; even the ACC’s appropriateness criteria say so: “The overwhelming majority of final ratings of cardiac RNI [i.e., nuclear stress testing] and stress echocardiography [i.e., sonographic stress testing] were concordant for similar clinical indications.” Nuclear and sonographic cardiac stress testing have nearly identical sensitivities and specificities; if anything, the specificity of sonographic cardiac stress testing even seems to be somewhat better."

Not surprisingly, from the comments section:

"This post might not generate much interest, but it should. Stress echocardiography is essentially equivalent to nuclear cardiac stress testing. The biggest differences are (1) echos don't expose the patient to levels of radiation equal to several hundred xrays (2) stress echos require more effort on the part of the cardiologist and are much less lucrative (3) nuclear testing is many times more common when a physician owns the equipment.
In a nutshell, stress echos could be utilized over 90% of the time, are safer and cheaper, but it's often not in the financial best interest of the ordering physician to do so."

There are a few instances, related to grotesque obesity and chest deformities, where the echo cardiogram cannot couple properly with the chest and Nuclear Test would be warranted.
Posted 8/10/2014 3:53 AM (GMT 0)
jungRuiz: Thank you so much for the research and thoughtful response. My health care facilities are owned by the doctors. I am not surprised by your findings.
Posted 8/10/2014 5:39 AM (GMT 0)
Welcome to the forum, and I am sorry for your distress, but it is good that your EKG is normal. Best of Luck to you, I am sure you will be ok. And well said JungRulz.
Posted 8/10/2014 9:34 PM (GMT 0)
You can do an echo with stress test and EKG, will give more information.

If the problem may be in your arteries, there is a specific test for that that involves running dye through them.

If you are female I understand all of this is harder as the disease could be harder to find.

Dora
Posted 8/11/2014 5:38 PM (GMT 0)
Thanks to all for your advice and support. I wish you all blessings and good health.
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